Malaria continues to be a leading cause of morbidity and mortality in many countries, especially in Sub Saharan Africa. In Kenya, malaria alone accounts for 30% of outpatient admittance and up to 5% of inpatient deaths while 170 million working days are lost annually because of it.

In 2004, Kenya changed its malaria treatment policy opting for the use of artemisinin based combination therapy (ACT) as first-line therapy for uncomplicated malaria. This led to a more effective treatment regimen yet it was noted that improvement of malaria case management requires not only the correct use of effective medicines but also ensuring that patients are accurately diagnosed and appropriately managed.

On October 4, 2012 malaria rapid diagnostic test kits (RDT) were nationally launched, marking another milestone in the fight against malaria. The launch is expected to scale up the diagnosis of malaria using RDTs nationally and promote appropriate use of anti-malarial medicines.

The USAID-funded Health Commodities and Services Management (HCSM) program[1], led by Management Sciences for Health (MSH), provided support to the Kenyan Division of Malaria Control (DOMC) for the development of the RDT roll out plan, including roll-out processes and procedures and an emphasis on quality management and monitoring and evaluation.

Speaking during the launch, Dr. S.K Sharif, Director of Public Health and Sanitation, said that evidence showed that Kenya has made significant strides in the fight against malaria in the past ten years and that the launch of the RDTs would see the country go to the next level in the fight against malaria.

“The 2010 malaria indicator survey points out that the malaria prevalence in the country is dropping from 40% to lower than 20% across the country with low transmission areas having prevalence of below 1%. However significant proportions of the population in the lake region still bear a high prevalence and it is no longer appropriate to equate fever with malaria, thus the need for a parasitological confirmation of every suspected case of malaria before giving appropriate treatment,” said Dr. Sharif.

“These RDTs kits will complement the efforts made by the ministry in strengthening malaria diagnosis,” he added.

The launch was attended by various development partners including USAID, Presidential Malaria Initiative (PMI), UKAID, UNICEF and WHO, all who congratulated the ministry for achieving such a milestone and pledged to continued support in the fight against malaria.

Test, Treat and Track

The management of malaria has previously been based on the clinical symptoms of a patient under five in malaria endemic zones. It became necessary to embrace a universal diagnostic policy for all age groups and all zones regardless of the endemicity to successfully provide universal malaria treatment.

Based on global recommendations, the Kenyan government adopted a policy of universal diagnosis of malaria for all ages and across all areas in the country. Any and all suspected malaria cases would be tested and those found to be positive would be treated with the recommended anti-malarial medicines and therapy.

In a bid to strengthen malaria diagnosis and implement the policy, the ministries of health with support from various development partners procured approximately eight million RDTs for distribution and use in 2012 and a further eleven million are targeted for 2013.

The deployment of diagnostics has in the past been reserved for hospitals and large health facilities with microscopy services and with formally trained laboratory technicians and technologists. However, procured RDTs kits will be distributed to all public and faith based healthcare facilities across the country with priority given to facilities which currently do not provide other diagnostic services for malaria. The deployment of RDTs by DOMC will expand diagnostic coverage all the way down to the dispensaries (Level 2 facilities) with a target to roll them out to the community health workers in 2013.

HCSM is currently involved in training 3,200 frontline health workers on the use of RDTs in lower level facilities countrywide as well as provision of technical assistance to ensure that RDTs and other malaria commodities are managed appropriately at the facility level.

Benefits of RDTs

The RDTs represent benefits across all areas of the healthcare delivery system; specifically patients are diagnosed and treated correctly while in health facilities. With improved diagnosis, forecasters can better estimate the medicines needed to treat malaria cases, saving a lot of money on a surplus of medicines.

Additionally, the threat of parasites becoming resistant to medicines is reduced if diagnosis-based treatment is used. This subsequently increases the useful therapeutic life of the available medicines and reduces the chances of changing treatment guidelines to more expensive alternatives.